Common Eye Emergencies



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Am Fam Physician. 2013 Oct 15;88(8):515-519.

This clinical content conforms to AAFP criteria for continuing medical education (CME). See the CME Quiz.

Author disclosure: No relevant financial affiliations.

Ocular emergencies such as retinal detachments, mechanical globe injuries, and chemical injuries can cause permanent vision loss if they are not recognized and treated promptly. Family physicians should be familiar with the signs and symptoms associated with each condition, and be able to perform a basic eye examination to assess the situation. The assessment includes measurement of visual acuity, pupillary examination, visual field testing, slit lamp or penlight examination of the anterior segment of the eye, and direct funduscopic examination. Patients with symptomatic floaters and flashing lights require a dilated fundoscopic examination and prompt referral to an ophthalmologist for evaluation of a retinal tear or detachment. A globe laceration or rupture should be suspected in patients with a recent history of trauma from a blunt or penetrating object. Prophylactic oral antibiotics can be administered after a globe injury to prevent endophthalmitis, and the eye should be covered with a metal shield until evaluation by an ophthalmologist. Chemical injuries require immediate irrigation of the eye to neutralize the pH of the ocular surface.

Ocular emergencies have the potential to cause permanent vision loss if they are not promptly recognized and treated. Ocular emergencies include retinal detachments, mechanical globe injuries, and chemical injuries (Table 1). Family physicians should be familiar with the signs and symptoms associated with each condition, and be able to perform a basic eye examination to assess the situation.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating References

Patients who notice symptomatic floaters and flashing lights should be referred immediately to an ophthalmologist for evaluation of a retinal tear or detachment.

C

5

Patients with a suspected globe injury should be referred immediately to an ophthalmologist.

C

16, 17

Prophylactic systemic antibiotics should be administered to prevent endophthalmitis after a globe rupture or laceration.

C

20

A chemical eye injury should be irrigated with lactated Ringer's solution or normal saline until the pH of the ocular surface is within the normal range.

C

22, 27


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

View Table

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating References

Patients who notice symptomatic floaters and flashing lights should be referred immediately to an ophthalmologist for evaluation of a retinal tear or detachment.

C

5

Patients with a suspected globe injury should be referred immediately to an ophthalmologist.

C

16, 17

Prophylactic systemic antibiotics should be administered to prevent endophthalmitis after a globe rupture or laceration.

C

20

A chemical eye injury should be irrigated with lactated Ringer's solution or normal saline until the pH of the ocular surface is within the normal range.

C

22, 27


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

Table 1.

Management of Common Eye Emergencies

Emergency Initial management Ophthalmic management

Retinal tear or detachment

Refer to ophthalmologist immediately

Dilated fundoscopic examination; retinal laser for small retinal tear with no detachment; surgical repair with pneumatic retinopexy, scleral buckle, or vitrectomy for retinal detachment

Mechanical globe injury

Place metal shield over eye; prescribe antiemetics and systemic antibiotics; update tetanus immunization; refer immediately to ophthalmologist or emergency department

Orbital computed tomography to evaluate for fractures and intraocular foreign bodies; immediate surgery to repair the laceration; monitor for endophthalmitis and sympathetic ophthalmia

Chemical eye injury

Irrigate eye with normal saline or lactated Ringer's solution with at least 2 L of fluid; continue irrigation until pH is normal, then refer immediately to ophthalmologist or emergency department

Topical antibiotics and artificial tears for mild burns (grade I or II); topical antibiotics, artificial tears, steroids, ascorbate, and citrate drops for severe burns (grade III or IV)

Table 1.   Management of Common Eye Emergencies

View Table

Table 1.

Management of Common

The Author

CHRISTOPHER D. GELSTON, MD, is an assistant professor of ophthalmology at the University of Colorado School of Medicine, Aurora.

Address correspondence to Christopher D. Gelston, MD, University of Colorado School of Medicine, 1675 Aurora Ct., Mail Stop F-731, Aurora, CO 80045 (e-mail: christopher.gelston@ucdenver.edu). Reprints are not available from the author.

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